Transcript COMPARACIÓN ENTRE PAQUIMETRÍA ÓPTICA Y ULTRASÓNICA

Autologous serum eye drops in
severe post-LASIK dry eye.
Alberto Arntz MD, Andrea Cruzat MD, Arturo Grau MD.
Pontificia Universidad Católica de Chile
The authors have no financial interest in the subject matter of this
poster.
Autologous serum eye drops are not FDA aproved.
Purpose
To evaluate the efficacy and safety of
Autologous Serum eye drops for the
treatment of severe post-LASIK dry eye
syndrome.
Methods
Inclusion Criteria
• Patients with no previous dry eye history, who underwent
uneventful LASIK and presented severe dry eye signs 4 weeks
after surgery in spite of conventional unpreserved artificial
tears therapy.
• Severe dry eye diagnosis was stablished when the patient met
all three criteria:
– 2 lines lost of best-spectacle corrected visual acuity
(BSCVA).
– Corneal fluorescein staining score (FSC) ≥ 1.
– Residual astigmatism ≥ 1.0D
Methods
Corneal Fluorescein Staining Score (FSC)
0
1
No staining
Isolated punctate
staining
2
Confluent inferior 1/3
corneal surface staining
3
Confluent inferior 1/2
corneal surface staining
4
Diffuse and complete
corneal staining
Methods
Recruitment and Follow-up
- Recruitment during one year period.
- Patients who met inclusion criteria were enrolled after
informed consent.
- Autologous serum was obtained and prescribed 6 times a
day for 1 month.
- 3 months follow-up with monthly visits.
- Parameters evaluated every visit:
Best-corrected visual acuity (BCVA)
Residual refractive astigmatism (RA)
Corneal fluorescein staining score (FSC)
Adverse effects
Methods
Autologous Serum preparation
• 100 ml of venous peripheral blood collected and clotted at
room temperature for three hours.
• Centrifuge for 10 minutes at 3000 rpm.
• Supernatant serum extraction and dilution to 20% in
balanced salt solution.
• Portions of 5 ml aliquoted into sterile dropper bottles,
and labelled with name of the patient and date of
production.
• Bottles stored frozen at -20ºC.
• Every bottle used for 1 week, 6 times a day, stored at 6ºC
and discarded after that period.
Results
• After recruitment period of 1 year, 14 eyes (8
patients) who met the inclusion criteria were
enrolled from nearly 500 LASIK procedures.
• 100% women.
• Mean age: 33 ± 9 yo.
• Preoperative spherical equivalent: 2.6 ± 3.5 D
( range +3.7 to -7.75 ).
• No adverse effects were observed.
Results
BSCVA
1
snellen
0,8
0,6
0,4
0,2
0
preop
w eek1 month 1 month 2 month 3
Change in BSCVA after LASIK surgery. The green and red arrows
represent the beginning and the end of the AS period of treatment.
Results
Residual
Astigmatism
(RA)
Astigmatismo
inducido
2
Diopters
1,5
1
0,5
0
preop
week1
month1
month2
month3
tiempo
Change in RA after LASIK surgery. The green and red arrows
represent the beginning and the end of the AS period of treatment.
Results
Fluoresceinic Staining Score (FSC)
2,5
score
2
1,5
1
0,5
0
preop
w eek1
month1
month2
month3
Change in corneal FSC after LASIK surgery. The green and red arrows
represent the beginning and the end of the AS period of treatment.
Results: Main Outcome measures
Pre
Residual
Astigmatism
(diopters)
1.15 ± 0.84
Post
p
0.63 ± 0.47
Non
significant
BSCVA
0.55 ± 0.20
0.7±0.12
Corneal fluorescein
staining score
2.1 ± 1.03
1.1 ± 0.37
<0.05
<0.005
Main outcome measures pre and post autologous serum treatment: BSCVA=
best spectacle corrected visual acuity in snellen equivalent; Values presented
as media ± standard deviation. P = statistical level of significance.
Conclusions
• Our study suggests that autologous serum is a safe and
effective alternative that improves visual function and
reduces ocular surface damage in severe post-LASIK dry
eye unresponsive to conventional non-preserved artificial
tears.
• A slight regression in the corneal epithelial fluorescein
staining score after AS withdrawal suggests that
treatment time should be longer than four weeks.
• Long prospective doble-blind studies are needed to
confirm our study results.